Short Sale Authorization

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This document has legal consequences. ©ST.

LOUIS ASSOCIATION OF REALTORS ®


If you do not understand it, consult your Approved by Counsel for the St. Louis Association of REALTORS ®
attorney. to be used exclusively by REALTORS ®
Form # 2177 2/08

Authorization to Release Information

DATE:

PROPERTY:

OWNER(S) PRINTED NAME: , SSN

OWNER(S) PRINTED NAME: , SSN

LOAN #

Lien Holder(s), its successors and/or assigns:

I authorize the holder of the above referenced loan(s) to discuss my mortgage and any information regarding this
property, including short sale, foreclosure and bankruptcy status, marketing, offers and closing expenses with
my agent and/or Broker

with REALTOR® (Company)

and title company: .

It is understood that a copy of this form will serve as my authorization.

OWNER DATE REALTOR® (Company)

OWNER DATE AUTHORIZED AGENT DATE

Phone Office Phone

Fax Office Fax

Cell Phone Authorized Agent Cell Phone

Email Authorized Agent Email

Printed Using Professional Computer Forms Co. On-Line Forms Software 8/09

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